A Case of Allergic Bronchopulmonary Aspergillosis Forming Broncholith Misdiagnosed as an Uncontrolled Asthma with Broncholithiasis

A 55-year-old woman was referred to the division of pulmonology at Severance Hospital for the investigation of uncontrolled asthma with recurrent cough at night, blood-tinged sputum, malaise, and wheezing since 3 months. Chest computed tomography revealed bronchiectasis and broncholithiasis in the lateral segmental bronchus of the right middle lobe and the anterobasal segmental bronchus of the right lower lobe. Bronchoscopic broncholith removal was performed because of recurrent blood-tinged sputum and the outflow of purulent exudate behind the broncholith in the lateral segmental bronchus of the right middle lobe. The extracted material presenting amorphous eosinophilic necrotic materials with calcification was compatible with broncholithiasis. Following decalcification, histopathology revealed degenerated septate fungal hyphae and spores that were morphologically consistent with Aspergillus spp. A final diagnosis was allergic bronchopulmonary aspergillosis (ABPA) forming broncholith. The results from this case suggest that the early recognition of ABPA should be considered in patients with uncontrolled asthma accompanied by broncholithiasis.

Thoracicl Actinomycosis Associated with Broncholithiasis: Report on 2 cases / 대한흉부외과학회지

We report here on two cases of a 48-year old woman and a 46-year-old man who both presented with broncholithiasis and obstructive pneumonitis. Removal of the broncholithiasis failed with bronchofibroscopy, and so right middle lobectomy of the lung were done in the 2 patients. The histopathologic diagnosis was thoracic actinomycosis associated with broncholithiasis. Thoracic actinomycosis associated with broncholithiasis is a very rare condition, so we report here on these two cases of thoracic actinomycosis associated with broncholithiasis.

Broncholithiasis Caused by Actinomycosis / 대한흉부외과학회지

A 32 year-old man was transferred to our hospital due to blood-tinged sputum for 15 days. He had been treated at a private hospital for recurrent pneumonia. The chest X-ray showed an atelectasis on the right middle lobe. Computed tomography of the chest demonstrated a broncholith on right middle lobar bronchus with lobar atelectasis of the right middle lobe. We tried to remove the broncholith through fiberoptic bronchoscopy, but could not remove it. Therefore, we performed surgical removal of broncholith and the right middle lobectomy. The cause of broncholith was identified as actinomycosis by pathologic examination. The broncholith caused by actinomycosis is rare. We report a rare case of broncholithiasis with recurrent obstructive pneumonia caused by actinomycosis, which was treated by surgical operation.

Bronchoesophageal Fistula Complicated by Broncholithiasis in a Patient with Silicosis: 1 case / 대한흉부외과학회지

Broncholithiasis is uncommon in patients with silicosis. Bronchoesophageal fistula complicated by broncholithiasis is especially rare and only one case has been reported in Korea. Surgical treatment of broncholithiasis should be as conservative as possible to preserve the adequate pulmonary function. Meticulous dissection and division of the fistula with the interposition of viable tissues will prevent recurrence. We report a rare case of bronchoesophageal fistula complicated by broncholithiasis in a patient with silicosis.

A Case of Broncholithiasis Caused by Aspergillus with Broncho-Obstructive Pneumonia and Massive Hemoptysis / 결핵및호흡기질환

A broncholith is a calcified mediastinal lymph node, which partially or completely erodes into the bronchial lumen, and is related to the late tissue response to healing of granulomatous pulmonary infections, most commonly histoplasmosis or tuberculosis. However, there have been a few reports on broncholithiasis caused by Aspergillus. We experienced a case of broncholithiasis caused by Aspergillus, with broncho-obstructive pneumonia and massive hemoptysis. A 39 year-old woman was admitted to our hospital with right middle lobar pneumonia. On the fourth day following admission, massive hemoptysis developed, so an emergent bronchial artery embolization was performed. On the ninth day following admission, a broncholith on the lateral segmental bronchus of the right middle lobe was found by bronchoscopy, which was proved to be Aspergillus hypae with calcification on histological examination. After the simple bronchoscopic removal of the broncholith and empirical antibiotic therapy, the patient recovered without any complications.

A Combined Case of Endobronchial Lipoma and Broncholithiasis

Endobronchial lipomas are rare lesions that usually obstruct a major bronchus and cause irreversible pulmonary damage distally. Herein, a case of an endobronchial lipoma combined with broncholithiasis, found 3 months after first noticing symptoms including dry cough, and voice change, successfully removed by surgical resection is reported

A Case of Broncholithiasis caused by Aspergillus / 결핵

Broncholith is a calcified lymph node which partially or completely erodes into the bronchial lumen and broncholithiasis is a relatively rare condition which related to late tissue response to healing granulomatous pulmonary infections, most commonly histoplasmosis or tuberculosis. The prominent symptoms of broncholithiasis are coughing followed by hemoptysis and symptoms related to bronchial obstruction. The complications include bronchoesophageal fistula and aortotracheal fistula. We report one case of broncholithiasis caused by Aspergillus. The case was a 53 year-old house wife whose chief complaints were recurrent fever, chill and malaise. The chest film revealed an ovoid hazziness on the right middle lobe and chest CT scan showed consolidation of lateral segment of right middle lobe with calcified small low attenuated lesion in right middle lobe bronchus. Aspergillosis confirmed by pathology after bronchoscopic removal of impacted Aspergillus containing muddy plug from lateral segmental branch of right middle lobe bronchus.

A Clinical Review of Broncholithiasis / 결핵

BACKGROUND: Broncholithiasis is uncommon but clinically important because it may cause a variety of nonspecific symptoms and signs prior to the onset of lithoptysis, and rarely massive hemoptysis. METHOD: A retrospective clinical study was done on 11 case of broncholithiasis diagnosed at Kyungpook National University Hospital from Jan. 1985 to Dec. 1993. The study investigated the clinical features, radiologic findings, bronchoscopic findings and management. RESULTS: 1) The common symptoms included cough, dyspnea, hemoptysis, fever and purulent sputum. Lithoptysis occurred in 3 patients. 2) The radiologic findings were variable and nonspecific. Hilar calcification and parenchymal calcification were the most common findings. 3) The bronchoscopy was performed in 10 patients and revealed broncholiths in 9 patients. 4) Chemical composition of broncholiths was analyzed in 2 patients. Calcium carbonate was main component. 5) In 6 out of 9 patients in whom broncholiths was revealed by bronchoscopy, broncholiths were successfully extracted through the flexible bronchoscope. 6) In 9 patients, broncholithiasis was related to tuberculosis and in 1 case, related to silicosis. CONCLUSION: Broncholithiasis shows a variable clinical spectrum. Tuberculosis is the most common cause of broncholithiasis. In the case of no accompanied complication, nonsurgical management such as bronchoscopic removal and conservative therapy is an effective measure.